June 25, 2007

If you get your medical information from the press, you probably believe that Type 2 diabetes is a self-inflected disease caused by obesity and that it could have been prevented if the lazy gluttons who get it had only watched their weight.

This makes it very easy to view people with Type 2 as greedy layabouts who caused their disease and to begrudge them their share of society's limited health care dollars.

People with Type 1 often express their anger and resentment that they have to share the name of their disease with all those lazy fat people, when the Type 1s disease is not their fault.

But the theory that Type 2s are greedy slobs who cause their disease, though appealing to our prejudices, is crap.

There are many thousands of people who have been diagnosed as Type 2s who are not fat. Last year I attended a get together of a bunch of us who met by posting on an online bulletin board. What we had in common, besides a Type 2 diabetes diagnosis--which is what my doctor still puts on my paperwork--is that we were all of normal weight. There were quite a few overweight people in the cafe with us the afternoon we met, but they weren't the diagnosed diabetics.

And more importantly, despite attaining normal weights, all of us who met that day still have seriously impaired blood sugar. Two of us, in fact, use insulin to get better control.

Part of the reason for the association of diabetes with obesity is that people with diabetes often are very fat. But what gets missed is that their obesity often develops as a result of the very high blood sugars, rather than the other way around.

We know now that blood sugars of 180 mg/dl or higher cause insulin resistance and there appears to be a strong relationship between insulin resistance and the tendency to pack on weight. So when people's post-meal blood sugar control starts to deteriorate one of the first things that happens is that they pack on extra pounds.

This relentless weight gain often happens during the ten years or so that the typical Type 2 is running diabetic blood sugars after every meal but before they get a diagnosis--the same ten years of undiagnosed high blood sugars that ensure that at the time of diagnosis almost half of all "newly diagnosed" Type 2s already have serious diabetic complications, including nerve damage, retinal changes, and early signs of kidney deterioration which take a decade to develop.

Hence, for many type 2s, that overweight that doctors think has caused their diabetes is really just another complication caused by their years of exposure to high blood sugars. Even more important, this weight gain can often be reversed by cutting out the carbohydrates that raise blood sugar, though resuming normal weight rarely results in our diabetes reversing.

Another fact that gets lost when the media, and even doctors, blame people for their diabetes is this: that only a small proportion of even the most obese people ever develop diabetes--something like 1/3 of them. The rest just end up very fat with normal or near normal blood sugars.

That is because a huge body of research has shown that people only develop diabetes when they have underlying genetic conditions that are not well understood, but which are clearly there, since twin studies show a high concordance for diabetes. Even more interestingly, studies of thin relatives of people with type 2 diabetes show that they show subtle blood sugar abnormalities while they are thin and fit--decades before they themselves are diagnosed with Type 2 diabetes.

I have written up some of the more interesting research on this topic on my page:

Quite a few people diagnosed with Type 2 diabetes have written to me that this page saved their sanity after diagnosis. Even more have written to me of their anger at doctors who had told them that, if they could just lose ten pounds, their diabetes would reverse when they were at normal weights already.

Similarly, it seems like almost every week I get emails from people who have been diagnosed with Type 2 diabetes who are not fat, but whose doctors are so sure that diabetes is caused by obesity that they can't even take in the evidence of their own eyes.

Even worse, a lot of people, like myself, go for years--in my case 13 of them--without a diabetes diagnosis because doctors take one look at their size 8 slacks and say, "You couldn't have diabetes, you are thin," despite the presence of classic tell tale symptoms like UTIs, yeast infections, fluctuations in vision, exhaustion after eating carbs, and in my case, gestational diabetes during not one but two pregnancies.

I thought for years my situation was unique, but the mail I get makes it clear it is not.

Unfortunately, the media will write up with enthusiasm stories of hugely overweight people who reversed their Type 2 diabetes by losing weight. Some of these people do exist, though in my experience of reading about the experiences of literally thousands of people with Type 2 diabetes online, the people who do this are almost always male. But they are not typical of all Type 2s at all.

It is a shame that the media will not describe the stories of people like me who exercised, kept slim, and developed diabetes anyway. I wish they would. Any journalist who would like it interview me can click on the link by my profile above. Just promise you'll be willing to photograph me in my size 8 pants injecting insulin.

49
comments:

Anonymous
said...

I got the same thing for years before actually getting a diagnosis and treatment for my PCOS - "you're too normal weight to have it." Once I began to gain weight and insulin resistance became apparent, the docs came to their senses. But I can't help wondering how things might have been different if I had been diagnosed in my teens rather than my thirties.

Once again, you tell it like it is. I am one of those people you describe.

I had a hunch about my blood sugar, looked for more info for the past several years, found exactly what I was looking for on your site.

Then I realized that my doctors were incapable of diagnosing my glucose impairment because they were blinded by my normal weight and "normal" screening (fasting) results (which were normal solely due to the low carb diet that I have followed the past 3 years). Finally getting a GTT gave them something to think about! They still don't understand it though and can't figure out how I can be normal weight and have such bad glucose tolerance. But thanks to your website,* I * understand it and know how to deal with the doctors better than before.

Even after finding your wonderful website, I have continued my search for more information that may be useful in learning more about my condition. I might as well stop because I can find no other source of information that tops yours. Thanks again,Anna

This condition is plagued by misinformation and inaccurate facts. Thanks for a very well-written post (as well as article), and very much-needed, too! I believe you did a terrific job by citing the scientific and medical journal references, which is so often absent from many otherwise good articles I read elsewhere.

I just got diagnosed with diabetes when to my horror my doctor told me that my fasting blood sugar was 275!! I have no idea how it went from 109 to 275 in 1 1/2 years but it did and now I fear I will never be able to eat normally again and will have to become the strict dietician despite me being 6'3 and 167. (Hardly what toy'd call the typical type II diabetic. I'm also only 29! So yes, I still have trouble believing this could be true but I guess reality sucks.

I was just diagnosed with a similar case as anonymous. 35, 6'3", 165 lb guy who is very fit and active. I had a glucose over 300 and have tested negative for antibodies; diagnosed as Type 2. Everything about my case screams Type 1 except for the absence of antibodies. So more to support the case that obesity (or inactivity) does not cause Type 2 diabetes.

Somehow we have to get a media blitz on this! I know so many skinny young people now with type 2 and so many fat 60 plus-year-olds who eat like pigs and are obese with no diabetes! Something in our environment is killing us and giving us this disease. We have to get national TV time somehow.Can someone set up a donation site?for TV Time?

I too am not the so called typical type 2 diabetic. I was 134lbs 5'6" 27 year old male diagnosed with type 2 diabetes, been keeping my A1c between 5.4 and 6.1 since my first initial A1c of 14. The docotor has me on Avandamet since that diagnosis 2 years ago. My latest A1c was 5.8. I have not gone to see an endocrinologist yet, should I?

I have diabetes when i was 14, and now I'm 19. I was never really diagnosed of the disease but I just figured it when I got symptoms like polyuria (frequent urination, polyphagia and polydipsia and, neuropathy vision problems and I'm easily exhausted. one thing is my both grandmas are diabetic and i have a poor eating habit in those days because I crave for sweets.. Yet, one of my troubles is I am very thin for my height 120lbs at 5'8"...I feel sad for myself and feel jealous to persons same age as mine who are strong and can do what they wish.My case was Type 2 because I don't use insulin yet I am still living.I have many regimens but I don't use madical drugs though I tried metformin/glucophage but I think my condition will become worse if I persue unto it.I admire your blog. I wish I'll get cured...could it be possible? are the sites in the net claiming for a cure to it are craps? or is there few that are honest about a cure for it...what do you use for your disease? what are your regimens?

With the early age that your diabetes came on and your being thin, it is very possible you do not have Type 2 Diabetes, but one of the forms many doctors now call "Type 1.5."

These are forms where insulin production fails either because of autoimmune attack or because of an in-born genetic error.

If that is what you have you MUST find a doctor to do one of two things: test whether using the drug gliclazide or Amaryl helps--which would show that you have a genetic problem, and if it does not, put you on insulin.

There are no "cures" for diabetes. Those web sites are run by vultures who prey on the sick.

There are excellent treatments that can restore health. But you must find a knowledgeable doctor who is up-to-date on diabetes treatment because without treatment your future will be grim.

Avandamet contains Avandia which has been found to be a poor choice of drug for people with diabetes. You should talk to the doctor about using only Metformin. Actos is not much better, healthwise, than Avandia so it is not a good alternative.

But that said, most endos won't do much for you if you have excellent control, so unless a visit is paid for by your insurer, it might be a waste at this point.

But DO talk to whoever prescribed the Avandamet and ask them to change it to plain metformin!

Jenny, HELP! I was diagnosed at 16 years old and I am now going on 26. They told me I had Type 1 for 9 years and treated me with low doses of insulin and pills that I didn't take seriously. I was in denial. Three years ago I vowed to not let Diabetes kill me and take away my quality of life and went to an Endo to seek help. They finally told me I had Type II since I had normal C Peptide results. They have tried every oral med for Type II without good results and now I take Lantus Solostar, Byetta and Actos daily. I still have bad glucose readings and have more recently figured out that I can go to bed with a 96 BG and wake up with a 150 BG. I started to take my BG at 2am and realized I am rising overnight. My meds aren't helping my swings because I am on a slow acting insulin. I think that I am a candidate for a pump, but my health care provider isn't keen on it. They won't even let me take more insulin. I need it though. I can tell by my body and BG. Do you have any suggestions for me? I want to be able to use more insulin. I eat incredibly well since I an frightened, but still experience after meal highs of 200. I'm frustrated with my diabetes and situation.

Sounds like time to find a different endo, perhaps one at a research university clinic who is more up to date with diagnoses and treatments.

Byetta, Actos and Lantus all at once is NOT an appropriate combination of drugs for anyone. Especially with the blood sugars you are reporting. Sounds like you you should definitely be using meal time insulin.

It isn't necessary to have a pump to get great control. Using Levemir and an Apidra pen gives me perfect numbers I'll sometimes split a dose and do two shots, one at the time I eat and one an hour or two later.

But you are right to be concerned at the treatment you are getting and should not have to put up with it. If you can't see someone else, demand that you be switched to a fast acting insulin (NOT humalog which a lot of people have trouble with) and taken off the Byetta and Actos.

The only reason to take Byetta is if you are overweight and it is helping you with weight loss. It is not supposed to be prescribed with insulin.

I only began reading about diabetes this morning as my husband is concern about me being ill often.

I am 32 and rather thin; 5'6" (1.7 m) and weights 117 pound (53 kg). I have always been this size if not smaller. Imagine about the same height but only 45 kg!

Ever since I was young (say 7?), I feel like passing out pretty often; especially in crowded, noisy and humid places. My vision will get blurry and I will have difficulties breathing (short breaths).

It take a very long time for any bruises to heal. I still have a bruise from an insect bite from over 6 months now!

Over the past 3 years, I contracted, UTIs twice. Maybe more because I did not know of such things.

I feel tired often. Gets extremely grumpy/moody when I am hungry.

Late 2008, I was diagnosed with depression. I refused to take any medication and see a specialist instead.

I quit my job around the time I was diagnose with depression and slowly build up to an exercise routine of 5 to 6 times a week for 1 to 2.5 hours per session. I really get tired after all the exercise and normally, take an afternoon nap on the 3rd day if I do a 2.5 hour session on 2 consecutive days.

To most, I don't seem really eat much but I think I eat enough for my tummy. I don't fancy sugary treats but do have ice-cream or dark chocolate when they are on special at the supermarket.

So, now, I am getting really concern about my health after reading all the symptoms of Type 2 Diabetes.

How many times a day does anyone typically have to medicate themselves (injections, etc...)?

I have type 2 diagnosed in December and the first drugs my dr prescribed were actos byetta and metformin er. I am having vision issues that have never occured before. Blur and loss of sharpness. I am sooooo exhausted that I lay down as soon as I get home. I can't eat. I can't drink. I have lost 12 pounds! Yeah! I guess. My bs went from 309 to a steady range of 108-142. I have had nothing over that. Should I be concerned by the presumed side effects? Which meds are iffy? I am really tired and miserable most of the time. Help?!

I am also very atypical..I am a 19 year-old female, 97 lbs and 5 feet tall. I've never been very athletic and don't do extensive workouts, but I eat very healthily and keep in shape. I just had a 2-hour GTT over Christmas- my fasting was 96 (fine), but my 2-hour was 198!! So 2 away from a diabetic diagnosis (and I didn't even do the 3-day carb-heavy diet)...I've never had any diabetic symptoms, though.

From my menarche at age 15 until this past September, I only had about 6 periods, but started taking Ortho Tri-Cyclen Lo to regulate my cycles and it's worked great (my u/s showed small ovarian cysts and I've had acne and a bit of hirsutism, but I'm still not the typical Poly-Cystic Ovarian Syndrome pt.) I'm also an asthmatic and have been on inhaled corticosteroids daily since age 3 or 4, so my endo. also wondered if this could've had an impact. BUT a corticosteroid stimulation test 18 months ago was totally normal.

Ok so it seems i have this problem too, i feel so unlucky to know fat old peopel can eat what they want and never develop it and here i am skinny 22 year old with impaired glucose tolerance! how do i fix this? it seems everyone is highlighting the problem but where are the solutions?

You may not "fix" the problem, but you control it by cutting way back on the carbohydrates you eat.

While this may make you feel "unlucky" by the time you are in your 40s your health will be a lot better than that of many seemingly "healthy" people who are developing heart disease and obesity.

If cutting back on carbs doesn't normalize your blood sugar, you may have a defect in insulin production or an autoimmune form of diabetes. Both are more common in thin people with abnormal blood sugar. In that case, an endocrinologist can help you and you can still expect to live a long and normal life with their help in controlling blood sugars.

There are some promising treatments in the work for people who are not producing insulin, too, that may lead to a real cure by the end of the decade.

The reason I went to the doctor and have a full blood test is because I lost 30 pounds in a year. I am 6" and now i weight 155lbs. Everithing on my blood was perfect except my BG @ 320 and my Ac1 at 13%. The Dr. put me in Janumed and Diamicron and after a couple of weeks of no major improvement, he asked me if I would consider insulin. After just 3 weeks on LANTUS, I am bellow 140 two hours after meals, and with an average of 97. I also take good care of my Carb intake and eat lots of protein. The only problem is that on ocassion, I have morning lows (60s) but I am asymptomatic and 10 minutes after breakfast I am back to a 100 or so.

My dietitian gave me a 2000 calorie a day plan to gain some weight. I follow it totally except for the carb part. (way to many in my opinion) I now eat around 45/50 grams of carb a day and take 20 units of insulin every day in a single shot. It is working for me and in just 1 month a a half since being diagnosed. I cannot wait another 1 1/2 to have my ac1 tested again.

It sounds like you need to reduce your lantus dose a bit or else inject in the morning rather than the evening. You don't want to risk hypos going lower.

Lantus is not meant to cover meals. It is only to cover the fasting state, but many doctors don't understand insulin dosing and will prescribe Lantus in doses that cover meals.

If you are thin you may be a Type 1 (LADA, the late onset type) and in that case you should see an endocrinologist and get a more sophisticated insulin regimen as time goes on with shots of fast acting to cover meals and only as much Lantus as you need to keep the fasting state steady.

Don't put off dealing with this. If you are low too often, you will lose your hypoglycemia awareness and can have very dangerous hypos in the 40s or lower.

The safest way would be to skip the night shot and then inject the next morning. Lantus doesn't last the full 24 hours for many people, so you might find you get a higher morning number at the same dose.

Thanks Jenny. I swithched from night to morning and the results couldn't have been better. I wake up in the higher 70s and have been having postpandrials at the 120 range after 2 hours regularly. My average since the switch (5 days) is at 98.

That's great news! People with diabetes are so often on their own with these matters. Doctors don't have the time to help, but fortunately, with some study it is possible to figure it out. The people on online discussion groups are very helpful too.

Thank you! I am a 38 year old female with a body mass index of 20(117 pounds at 5'3). I am a vegetarian and exercise on a daily basis. Yesterday I was told that I am prediabetic! Indeed, I was told to lose 5 lbs!!! I am going crazy! I can not stand it.

1. The vegetarian diet can be extremely high in carbohydrates. You may have inherited genes that limit your ability to process carbohydrates. Buy yourself a blood sugar meter, check your blood sugars 1 hour after eating, and if you see numbers higher than 140 mg/dl cut back on the starches and sugars until the numbers come down.

2. If you have a family or personal history of autoimmune disease of any type, demand that the doctor test you for islet and GAD antibodies, to make sure you aren't experiencing a form of slow autoimmune diabetes.

Some young skinny diabetics may actually have MODY diabetes, and older (35 plus) ones may have LADA. Both these types are fairly rare and are usually misdiagnosed as type 1 or 2. It's worth looking into, as the treatment strategeys can be quite different.

Money Maid, This is true and I discuss it on the main Blood Sugar 101 site, But there are still quite a few people who are normal weight who have Type 2. I hear from quite a few of them who have not tested for either LADA or antibodies.

Can't believe I haven't commented on this. I'm a ketosis prone T2 diabetic and this type of diabetes is known for not having antibodies, abrupt onset, (It's even classified as a type 1, T1b) It has also been noted that we are just as likely to be obese as thin. It is also fairly common.

I am 55, 5.4.5 and 8 and a half stone. I eat a good diet and walk for 40 minutes daily, or cycle. I have just been diagnosed with diabetes and it is such a shock. I was really hoping I could reverse it, but reading this, it sounds like that won't be possible. I can't bear it. I have a 6 year-old and a 10 year-old and I want to see them grow up. The idea of those dreadful drugs appalls me.sue

Go read the whole Blood Sugar 101 main web site, and you'll learn what you have to do to keep your blood sugars in the range that will give you a long and healthy life, whatever your diagnosis.

Lots of us do it, no matter what the diagnosis. Dr. Richard K. Bernstein is still practicing medicine in his late 70s after being diagnosed with Type 1 in 1946.

He did it without most of the very helpful tools we have now.

Get an accurate diagnosis--thin people may have LADA or MODY which isn't Type 2 and won't respond to the same drugs. But they will respond very well to insulin or other drugs. The more you read, the more you'll learn about how to use all drugs and diet safely and correctly.

The shock is understandable, but if you study up you can have a long and healthy life ahead of you.

Last August, I weighed 83 kg (183 lbs). I'm 5' 10", so a bit heavy but not obese. I felt pretty ropey one day and finally the wife dragged me to hospital where they discovered I had a serious kidney infection - and a blood sugar of 400 - with an HbA1c 0f 8.2%.

They treated the infection and sent me home as a Type 2 diabetic with lots of medication (Levemir and Prandin) They provided detailed advice and guidance on how to treat my condition. Most of this concerned diet and we've ignored that!

I now weigh in at 150lbs, and my A1c is 5.2%. All but one of the insulin pens are in the fridge and the Prandin hasn't been opened. If I've got a dodgy pancreas why would I want to push it to do the impossible?

So, I'm diabetic - fat, I'm not but I suspect that if I hadn't had the kidney infection (no apparent permanent damage it seems), I'd have been in the boat you describe - another year or two down the track with complications. Who says E-coli never does anyone a favour?

I remember reading that insulin resistance can manifest itself in more than one way.. sometimes the first to become resistant are the fat cells, sometimes it is other cells.. when it is not the fat cells first, the person can remain slender and may even have trouble gaining but is still just as vulnerable to the other problems related to insulin resistance such as heart disease and diabetes, etc.

It's also possible that your kidney infection made you temporarily diabetic.

Given the drugs prescribed, my guess is that your doctors knew something they didn't tell you explaining. Prandin is a very useful drug for certain kinds of diabetes that strike people who are of normal and near normal weight. In many cases the reason for their high blood sugar isn't that the beta cells are stressed or dead but that they've stopped secreting for some reason, possibly trauma. It's rarely prescribed to a newly diagnosed Type 2.

Alex,

Most thin Type 2s are NOT insulin resistant, but are instead victims of family doctors not knowing very much about diabetes and thinking, "Well, since this person isn't completely insulin dependent, they must be a Type 2."

Few run the tests needed to determine whether there are signs of early, slow-developing autoimmune diabetes and even endos who were trained a decade or more ago may not have heard MODY or the fact that there are quite a few as yet unidentified genetic causes of beta cell failure that are similar to it.

What an earlier respondent said about doctors being blinded by her normal weight really struck a chord with me. Except in my case it's the opposite.

I recently found out the results of my antibody testing. 415 for GAD65 (reference range 1-5). I was in DKA at the time. A later C-peptide test found I produce almost no insulin.

What was the official diagnosis? Type 2. Can you believe it?

I was normal BMI when diagnosed but *look* fat and had lots of belly fat. Also I have lots of acanthosis nigricans which shouts 'Type 2!' in big screaming letters to the doctors. It's so deafening that they ignored the results of the antibody tests; in fact they even told me I was antibody negative!!!

I am wondering if any of you might have some insight into this... I had a FBS of 119, and of course that was bad. I immediately began exploring info on these sites, trying to understand and like Jenny suggests (thank you), I began testing testing testing. I am also doing a very carb resticted diet until I can get a handle on this... This is what my testing shows. In the morning when I wake, my blood sugar is 85-92, if I test first thing upon waking. If I then eat a lo-carb breakfast and snack throughout the day, I can keep normal glucose all day long, with normall 1 hr pp and normal 2 hr pp. However, if I wait 2 hours after rising in the morning (still fasting) my glucose rises to 110-126, somewhere in there, even though I haven't eaten. Or if I go for a run when my glucose is 80-90, when I get back from the run, the glucose is 110-126. I have been testing for 3 weeks now, all the while on a low carb diet. I have lost 6 pounds in that time, but I am not that much overweight... maybe I have 6-9 more pounds to go... I was 10-15 pounds "overweight". 5"9" 165 to start and I should be 150-155. Mostly the fat I have is belly fat. I am a woman, 50 years old. I had gestational diabetes... but normal blood pressure, other lab work is normal. I would appreciate any ideas you may have...

It's normal for blood sugar to rise when a person doesn't eat in the morning. This is called "Dawn phenomenon" and discussed HERE.

Exercise can also raise blood sugar if you burn off your blood sugar causing the blood sugar to drop low. This causes a burst of stress hormones whose job is to push the blood sugar back up. If you are eating a very low carb diet, it is often a good idea to take a few grams of glucose every ten minutes to keep the blood sugar from going so low that this happens. 2 grams at a time may be enough. Sweetarts work very well.

As is so often the case it's tough to know what the underlying problem is. But fortunately, you have found something that helps correct it. If you burn out on eating extremely low carb, you should talk to your doctor about whether metformin might be helpful for you.

A quick follow up on the issue. Yes, it's very possible that the French endo decided that my French and/or my medical understanding wasn't up to a complex explanation of my problem. But I doubt it. During my hospital visit, they handed out pills without explanation. They seemed to have the old fashioned approach of "do as you're told and don't waste my time with questions".

I must have been considered a bit of a pest. Each time I got a tablet, I wanted to know what it was for. They handed me a painkiller. "for the pain" - "what pain?". Perhaps they could have checked first.

The levemir started at a dose of 20 units to be cut by 2 when I was below 80 for more than 2 days running (or upped at 120). By the end of 6 weeks, I was off it.

But temporary diabetic - I wish! All I need to do is eat something high carb and test after a couple of hours! What I find disappointing is that after that one hospital visit a year ago, no-one has followed up. They clearly have great confidence in GPs in France.

The kidney infection definitely pushed me into a DKA situation and at first I think they thought I was type 1 - despite my age. That's another minor issue I have - no-one has actually given me a formal statement of type - but acting as a type 2 does seem to be keeping the symptoms at bay - for now.

Jenny, thank you so much for the information... this site is so helpful... it's truly remarkable. I will be returning and devouring as much of this info that I can... I REALLY appreciate your taking your time to respond...Monica

You are seriously deluded. Your message is full of self-contradictions. You say that high blood sugar levels cause obesity and also diabetes, but then claim that you did not eat your way to diabetes. Are you supposing that sugar doesn't enter the body through one's mouth?Also no one said overweight people are mostly diabetic - pot bellied people are, regardless of whether or not they are obese in other body parts. They may appear perfectly fit to an untrained eye but if they undress and not tuck in their belly, then you know they are pot bellied.

I think you need to be careful here. "Obesity causes diabetes" does not mean "Only obesity causes diabetes" Nor does it mean "everyone who is obese will get diabetes" Compare "Smoking causes lung cancer" That's true, but it does't mean that non-smokers never get lung cancer (they do sometimes). Nor does it meant that every smoker gets cancer (many escape cancer). In both cases the risk factor RAISES THE CHANCE of the disease. You are more likely to get diabetes if you are overweight, just as you are more likely to get lung cancer if you smoke.

The flaw in your cancer analogy is this: we know for a fact that having cancer doesn't make you smoke, so that won't explain the association. However, most of the genetic research and much of the research about environmental chemical poisoning suggests that having diabetes in its earlyest undiagnosed state makes it much easier for people get fat. So the association between obesity and diabetes, while obviously real, may work in the other direction from the one usually presented.

This is either because these various factors either a) damage the feedback mechanisms that keep appetite in check or b) cause blood sugar fluctuations that cause relentless hunger.

The number of chemical and pharmaceutical factors now known to cause diabetes in people who wouldn't otherwise have it are enormous, with new ones discovered every year. And we know these impact on the fetus in the womb, causing permanent epigenetic changes that make diabetes much more likely and at early ages, for reasons that have little or nothing to do with lifestyle choices.

I am as aware of these factors as I am because I have been of normal weight all my life--except after my blood sugar when out of control (undiagnosed) when I was overwhelmed with a kind of hunger no normal person has ever experienced and which I knew could not be something due to bad habits, as at age 50 I knew myself too well. That packed 30 lbs on me in 1 year and had I gone undiagnosed, I could have easily gained another 100. When I got the blood sugar normalized, my weight did too.

Hello, Jenny. I am 36, weight 112 lb, 5'6", was a ballet dancer til 30, until a month ago exercised only once in a while, my diet was more carbs then meat or vegetables but pretty healthy overall, no fast food, no deep fried, no soft drinks etc. About a month and a half ago was sick with a virus and started to feel really dehydrated all the time, then started loosing weight which in my case is not good since I am already really thin and anemic. Lost 9 lb. in a 2 weeks which brought me to 103 lb. so just skin & bones pretty much..)) Started reading online, saw symptoms of diabetes included frequent yeast infections and remembered that I had like 3 in a row a few months ago and I dont normally get them ever. Bought a Blood Glucose Meter and was shocked. After a small portion of rice pudding 170, after a small bowl of oatmeal with 1 teaspoon of jam 240, 1/2 cup of puffed wheat with 1/4 cup of milk 180. It comes back down to below 100 after an hour to an hour and a half. Fasting in the mornings is 80 to 95. Got A1C done, it was 5.6. Doctor said not to worry about it for now and focus on the anemia, but I am really worried and after reading online I understand that spiking to over 200 after only 30 gr. of carbs is not normal! This happened on more than one occasion. I made an appointment to see an endocrinologist but its not for another 2 weeks. Please, any advice would help. I have been eating low carb, low sugar diet and started walking every day and test with the meter after meals to avoid spikes. Is it possible to spike that high and not be diabetic? And if so what can I do to prevent it from getting worse?

Unknown, Your blood sugar tests are not normal, but because you also have the anemia it is possible that whatever is causing the anemia could indeed be involved. The endocrinologist should run some tests that will make it clearer what is going on.

Eat what you have been eating the week before the endocrinology appointment. Cutting carbs may lower your blood sugar enough that it obscures what is actually going on and keeps you from being taken seriously. Many doctors, even endos, aren't aware of how strong an impact cutting carbs has on lowering blood sugar. After the appointment and any tests that are prescribed you can go back to eating low carb.

Until you know what is causing those elevated blood sugars it is hard to know if it is possible to prevent them from getting worse through steps you can take on your own. Some conditions that cause high blood sugar in thin people can be controlled with diet, others can't. When you get your diagnosis you'll be able to research what is the best approach for what is going on with you.

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Visit the mainBlood Sugar 101 Web Site to learn more about how blood sugar works, what blood sugar levels cause organ damage, what blood sugar levels are safe and how to achieve those safe blood sugar levels.

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I was diagnosed with diabetes in 1998. Since then I've kept my A1cs in the 5.0-6.0% range using the techniques you'll find explained at The main Blood Sugar 101 Web Site, where you'll also find extensive discussion of the peer-reviewed research that backs up the statements you read here.

I've also published two books on related subjects, Blood Sugar 101: What They Don't Tell You About Diabetes, which was an Amazon Diabetes bestseller for 3 years and Diet 101: The Truth About Low Carb Diets.